Public financing of health in developing countries: a cross-national systematic analysis
Public financing of health in developing countries: a cross-national systematic analysis
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DOI：
10.1016/s0140-6736(10)60233-4
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发表时间：
2010-04-17
期刊：
影响因子：
168.9
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Lu, Chunling;Schneider, Matthew T.;Murray, Christopher J. L.
背景 政府国内卫生支出是政府对其人民健康承诺的重要指标，对于卫生规划的可持续性至关重要。我们的目标是系统分析发展中国家政府卫生支出的所有可用数据源；描述卫生公共筹资的趋势；并测试它们与国内生产总值（GDP）、政府规模、艾滋病毒感染率、债务减免以及对政府和非政府部门的卫生发展援助（DAH）变化的相关程度。方法我们对发展中国家政府卫生支出（GHE-A）的所有可用数据源进行了系统分析，包括来自世界卫生组织和国际货币基金组织（IMF）的政府报告和数据库。 GHE-A 包括国内和外部资助的公共卫生支出。我们评估了这些来源的质量，并使用多重插补来生成 GHE-A 的完整序列。根据这些数据以及向政府提供的 DAH 数据，我们估算了政府在国内的卫生支出。我们使用面板回归方法来估计政府国内卫生支出与 GDP、政府规模、艾滋病毒感染率、债务减免以及向政府和非政府部门支付的 DAH 之间的关联。我们使用各种模型和国家子集检验了我们结论的稳健性。研究结果 在所有发展中国家，从 1995 年到 2006 年，国内来源的以不变美元计算的公共卫生融资增加了近 100%（国际货币基金组织 120%；世卫组织 88%）。总体而言，这一增长是 GDP 增长、政府支出占 GDP 份额略有下降以及政府卫生支出份额增加的结果。在国家层面，虽然许多地区的政府卫生支出份额有所增加，但许多撒哈拉以南非洲国家的政府卫生支出份额有所下降。统计分析表明，政府 DAH 对国内政府卫生支出产生了显着的负面影响，政府每增加 1 USS DAH，政府国内资源卫生支出就会减少 0.43 美元（p=0）至 1.14 美元（p=0）。然而，非政府部门的DAH对国内政府卫生支出产生了积极而显着的影响。这两个结果对于多个规范和子集分析都是稳健的。债务减免等其他因素对国内政府卫生支出没有明显影响。 解读 为了解决DAH对国内政府卫生支出的负面影响，我们建议对政府卫生支出和其他卫生相关部门的政府支出进行强有力的标准化监测；制定合作目标，以维持或增加政府卫生支出的份额；对发展中国家有效接收和使用DAH能力的投资；仔细评估将 DAH 扩大到非政府部门的风险和收益；调查使用全球价格补贴或产品转让作为 DAH 机制。
Background Government spending on health from domestic sources is an important indicator of a government's commitment to the health of its people, and is essential for the sustainability of health programmes. We aimed to systematically analyse all data sources available for government spending on health in developing countries; describe trends in public financing of health; and test the extent to which they were related to changes in gross domestic product (GDP), government size, HIV prevalence, debt relief, and development assistance for health (DAH) to governmental and non-governmental sectors.Methods We did a systematic analysis of all data sources available for government expenditures on health as agent (GHE-A) in developing countries, including government reports and databases from WHO and the International Monetary Fund (IMF). GHE-A consists of domestically and externally financed public health expenditures. We assessed the quality of these sources and used multiple imputation to generate a complete sequence of GHE-A. With these data and those for DAH to governments, we estimated government spending on health from domestic sources. We used panel-regression methods to estimate the association between government domestic spending on health and GDP, government size, HIV prevalence, debt relief, and DAH disbursed to governmental and non-governmental sectors. We tested the robustness of our conclusions using various models and subsets of countries.Findings In all developing countries, public financing of health in constant US$ from domestic sources increased by nearly 100% (IMF 120%; WHO 88%) from 1995 to 2006. Overall, this increase was the product of rising GDP, slight decreases in the share of GDP spent by government, and increases in the share of government spending on health. At the country level, while shares of government expenditures to health increased in many regions, they decreased in many sub-Saharan African countries. The statistical analysis showed that DAH to government had a negative and significant effect on domestic government spending on health such that for every USS1 of DAH to government, government health expenditures from domestic resources were reduced by $0.43 (p=0) to $1.14 (p=0). However, DAH to the non-governmental sector had a positive and significant effect on domestic government health spending. Both results were robust to multiple specifications and subset analyses. Other factors, such as debt relief, had no detectable effect on domestic government health spending.Interpretation To address the negative effect of DAH on domestic government health spending, we recommend strong standardised monitoring of government health expenditures and government spending in other health-related sectors; establishment of collaborative targets to maintain or increase the share of government expenditures going to health; investment in the capacity of developing countries to effectively receive and use DAH; careful assessment of the risks and benefits of expanded DAH to non-governmental sectors; and investigation of the use of global price subsidies or product transfers as mechanisms for DAH.